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L;NJ DISFL)—AL N01 .e, i :erased AN(: CEfRT'`1CATIGN FORM Generator Name 1_40t APC'7X701V, kfanifest Doc. No. : O O O Profile Number: State Manifest Nci.:_ 2138/q6, 19;, This form is submitted to .60OWZ-0 /.°E 500i'cd'S , :rte. in accordance with 110 CFR Part 268,which restricts the land d'apoW of certain ha ardou wastes. I. IVEhT1FICATION OF THE W.UTE 1 have identified my waste and marked the appropriate boxes) below to indicate how my waste must be managed to conform to the land disposal restrictions. A. Is this waste a oom-wasicwatef or a wastewater ? Check ONE: Non•Wastewater Lj Wastewater H. Identify ALL USEPA hazardous waste numbers that apply to this waste shipment (as defined by 40 CFR 261). For each waste numher, identify the corresponding subcategory (check NONE or write in the description from e0 CFR 268. 11, A2 or .i3) vsttk SCaeATrfAar L•AM svbiCA ar u.tea DOC-s ns:uxa•s — ..STs .n. -cwt l eesOl"IT" .rs-t .O. IWaIC DCSCRt►,ICM I To list additional USEPA waste number(s) and subcategory(s), use the supplemental shut provided (CWM•2001-B). If the supplemental page is used, check here: 11 11. HOW SfUST THE WASTE BE MANAGED ? Check the box(es) that indicate the Land Ban status of the waste. For any waste(s) that meets part of the treatment standard and requires additional treatment, you must mark (1) Box A (the.waste requires treatment) and (2) Box B.1 or B.2, or D (the waste satisfies part of the treatment standards). rein A. RESTRICTED WASTE REQUIRES TREATMENT Liu 1 am The initial gtnemmr of a nstmed waste(i.e..IoAent/diodt.California List.or scheduled waste)which must be treated to the appikabk fnalmcal standard set forth in 40 CFA Pan 0611 Subpar D and all ippliobk pmhibivTon tet forth m 40 CFR:6(1.71 or RCRA Seniors 700s(d)pror to!and disposal.This mqutmment applies to EPA hazardousas waste sumber(t) AND/OR the following California List constituents: (check W tint apply): Lj And, h(eul, �Cyanrdcs. 4HOfy KS,A copy of all applicable treatment standards and spenfied I"Itaist methods a czatauined at the treatment,storage and disposal amity named ions. B.1 RESTRICTED WASTE TREATED TO PERFOR.%tANCE STANDARDS The EPA hazardous waste number(s) hat been heated in cem)Viance with the appluab:e beCrfolRmis %tanfsrds speelfed In 40 CFR Pan 2.511 Subpart D. Swppotnng eau is a.vlable to be proatdnd As mquested by the A,nmag fanliry. 'I Cenlfy under fer.alry of!aw that 1 hes pcmor.ally tam,ned and am familiar with the Treatment technology and operation of The Irutmenl proceas used To sup)un this cendeutlon and thea,baud upon my Inquiry of:Noce indmduaY immediately maporsible for obtaining thea information,1 belies Q,the treatment prOCCas has been dperaled and maiGtaused properly So as 10 comply was the,rifoTance kr els mrAd in 40 CFR;an UA Subpart D and sat applicable prohlbdeotu rel tomb In 40 CFR.611-32 or RCRA Section)004(d)without dilution of the prohibited waste. I am ew em that then art significant penallas for Submitting a fax csrLresllon,including the part1biliry of a fine and imprisonment.* B2 RESTRICTED WASTES FOR WHICII THE TREATMENT STANDARD IS EXPRESSED AS A SPECIFIED TECHNOLOGY(AND THE WAS G HAS BEEN TREATED BY TEE SFECiFIED TECHNOLOG.1) 'I emir)under p.enatry of law that the wane has been treated in anordanee with the requirements of 40 CFA 269,41. 1 am[wan,that them are ttgruficaM penalllu rot submitting a fate cenefecacoq including the pocublliry of riot and imprisonment* This Ircairmni hu bun performed for-EPA hazardous waste numbet(t) C. RESTRICTED WASTE SUBJECT TO A VARIANCE The waste idennfed abo.s is sl.Drcct to a national rapacity waziuus, a Imatability V rlanK,or a cue-0yuu eneluion which elpma M This vananes apples To EPA hatardoua weale number(%) If di"I omni is a Ysdfetl or svrfa impouodmant,the wait must meet the avnlmum tuhnological requirements. (Noltl Wutea deep-it for deepK InIm"art selbien to a separate set of nriamei See ireatl4moret or 40 CFA Pan Ina.) D. RESTRICTED WASTE CAN BE LAND DISPOSED IATTHOLT FURTHER TREATMENT 1 am the initial ft"nelor of the following EPA haasrdoer waste oumber(S) 1 AAs dnemmfted that The wane meets all apptirabk IMAIMenl sraMArds cat forth in 40 CFR Pan :611 Subpart D.and all appllable ptobbilion kwtY cat l zona in section:19-31 or RCRA Semon 7o0t(a),and therefore m be Land disposed without further treatment. Acopy of W applicable treatment Standards and spcp6cd icalmenl methods a maintained n She treatmen,t.Storage and di%poaal fanliry named thews. '1 cenify under penalty one,that 1 penatamy hast eamined and aro familiar with the waste through analysis and taling or Ihnbw%h knot dge orlhe wipe to suppers Out cenrficateon that The waste complies with Ise tnatment standards spnified in 40 CFI(Pan Ic9 Subpart D and all applicabk prohibition let forth Be, 40 CFA 0432 or RCRA union 3004(d). I belies that the Information I submitted 4 true• anvrate and onapielc I res 1"m IMI there in s.Qtlfranl pemltca for eubmimng file certification•including the pwlbthry of a rine and impeisonenent' 1 hereby urea that all ' a ormation submitted to this and mai assoated documents u complete and auwate, to the best my knowledge sod information. Signature Date G�7.Q`90